Stewardship / Resistance Scan for Nov 21, 2017

Rise in Candida auris cases
Stewardship via telemedicine

US cases of Candida auris continue to climb

The number of reported Candida auris infections in the United States has risen to 157, according to the most recent case count from the Centers for Disease Control and Prevention (CDC).

As of Oct 31, the multidrug-resistant (MDR) fungus has been identified in healthcare facilities in 10 states, with New York (102) and New Jersey (33) reporting the most cases. Cases have also been reported in California (1), Connecticut (1), Florida (2), Illinois (9), Indiana (1), Maryland (1), Massachusetts (6), and Oklahoma (1).

The case count, which rose from 126 in September, reflects the number of laboratory-confirmed C auris infections. The CDC also reports that 29 patients have probable infections and 212 people have been found to be colonized with the pathogen. Colonized patients were identified by targeted screening in four states with clinical cases.

In patients with compromised immune systems, C auris can cause serious invasive infections affecting the bloodstream, heart, brain, ear, and bones. The CDC estimates that more than 1 in 3 patients with an invasive C auris infection die, and reports from other countries estimate mortality rates as high as 50%.
Nov 17 CDC case count update


Italian telemedicine consultation reduces antibiotic use, MDR bacteria

A telemedicine-based infectious disease consultation service at an Italian pediatric cardiac hospital helped reduce antibiotic use, overall antibiotic costs, and the selection of MDR bacteria, researchers report in the Italian Journal of Pediatrics.

The remote stewardship program, which was started in January 2015 after a cluster of pneumonia patients were admitted to the intensive care unit (ICU), consisted of a biweekly videoconference discussion of all clinical cases admitted to the hospital and a review of antibiotic strategies for each patient. Additional consultation with specialists was also available via telemedicine. The main topics discussed during the meetings were monitoring and managing of MDR Enterobacteriaceae, antibiotic prophylaxis protocols in surgery, and the difference between empirical and definitive therapy.

To measure the impact of the program on antibiotic appropriateness, costs, incidence of nosocomial infections, and incidence of isolation of MDR bacteria, the researchers compared the period immediately before the intervention (January 2014 through March 2015) to the post-intervention period (March 2015 through March 2016).

There were 683 patients in the pre-intervention period and 531 patients in the post-intervention period. The rate of hospital infections in the ICU per 1,000/person days decreased from 9.5 in the pre-intervention period to 6.1 in the post-intervention period, a difference that was not statistically significant. The rate of MDR isolation decreased from 104 to 79 per 1,000/person days, a reduction of 25%. In addition, the overall cost of antibiotics fell from €25,000 to €15,000, and average antibiotic packages consumed per admission fell from 9 to 6.7.

"In conclusion, the infectious disease meeting via telemedicine has been an effective tool for economic and professional development and multidisciplinary management of complex patients," the authors write. "The appropriate use of antibiotics reduced the multi-drug resistant bacteria selection, thus improving patient safety."
Nov 17 Ital J Pediatr letter to the editor

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